Germ Cell Tumours

Renu Maurya

8 years ago

INTRODUCTION:

AGE GROUP:

Malignant epithelial tumors	40-60yrs
Benign cystic teratoma	10-20yrs
Dysgerminoma	<20yrs
Endodermal sinus tumour	15-20yrs
Granulosa cell tumour	Post menopausal
Sertoli Leydig cell	20-30 yrs
Thecoma	Post menopausal

Classification of Germ Cell Tumors:

FEATURES:

Primary germ cell tumors (GCTs) of the testis, constitute 95% of all testicular neoplasms.
Infreguently, GCTs arise from an extragonadal site, including the mediastinum, retroperitoneum and, very rarely, the pineal gland.
Bilateral in 10% cases:Embryonal cell carcinoma
Cryptorchidism is associated with a several fold higher risk of GCT.
Abdominal cryptorchid testes are at a higher risk than inguinal cryptorchid testes.
Orchiopexy should be performed before puberty, if possible.
Alpha feto protein, LDH & p HCG are the markers for malignant germ cell tumors of ovary
Testicular feminization syndromes increase the risk of testicular GCT, and
Klinefelter’s syndrome is associated with mediastinal GCT.
Intratubular germ cell tumor found adjacent to Dysgerminoma
An isochromosome of the short arm of chromosome 12 is pathognomonic for GCT
A painless testicular mass is pathognomonic for a testicular malignancy.

Most malignant testicular cancer is: Choriocarcinoma
Serum alpha feto proetin level is elevated in non seminomatous testicular tumors.
Non seminomatous testicular tumors include
Yolk sac or endodermal sinus tumor
Embryonal carcinoma
Teratomas

Germ Cell Tumor Staging and Treatment
Stage	Extent of Disease	Treatment
Stage	Extent of Disease	Seminoma	Nonseminoma
IA	Testis only, no vascular/lymphatic invasion (T1)	Radiation therapy	RPLND or observation
IB	Testis only, with vascular/lymphatic invasion (T2), or extension through tunica albuginea (T2), or involvement of spermatic cord (T3) or scrotum (T4)	Radiation therapy	RPLND
IIA	Nodes < 2 cm	Radiation therapy	RPLND or chemotherapy followed by RPLND
IIB	Nodes 2-5 cm	Radiation therapy	RPLND +/– adjuvant chemotherapy or chemotherapy followed by RPLND
IIC	Nodes > 5 cm	Chemotherapy	Chemotherapy, often followed by RPLND
III	Distant metastases	Chemotherapy	Chemotherapy, often followed by surgery (biopsy or resection)

Exam Question

The most common pure germ cell tumour of the ovary is Dysgerminoma
Most common ovarian tumor in less than 20 years is Germ cell tumour
Bilateral germ cell tumour is Embryonal cell carcinoma
Choriocarcinoma is Malignant germ cell tumours of ovary
Alpha feto protein, LDH & p HCG are the markers for malignant germ cell tumors of ovary
Dysgerminoma, Polyembryoma & Endodermal sinus tumor are germ cell tumours of ovary
Most common germ cell tumor of ovary is Dermoid
The most common pure germ cell tumor of the ovary is Dysgerminoma
Serum alpha feto protein level is raised in Teratoma, Endodermal sinus tumor
Cryptochidism, Testicular feminising syndrome & Klinefelter’s syndrome are Predisposing features for germ cell tumour
Extragonadal germ cell tumors occur in Sacrococcygeal region, Mediastinum & Brain
The commonest site for extragonadal germ cell tumour is Mediastinum
Germ cell tumours of testis are Seminoma, Teratoma
Intratubular germ cell tumor found adjacent to Dysgerminoma
Treatment of extragonadal germ cell tumour is Chemotherapy
Seminomas are radiosensitive

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